Lake Street Family Dental PA

Lake Street Family Dental PA was paid $26K by Medicaid between Mar 2018 and Oct 2024, across 7 billing codes. Its largest line is D1110, Prophylaxis - adult — 42% of everything it billed.

33Billing provider infoLAKE STREET FAMILY DENTAL PA
MORA, MN 55051

33aNPI1083096085assigned 06/25/2015

33bProvider typeDentist

28Total paid$26K

24GClaims842

24DCodes billed7

24AFirst – last monthMar 2018 – Oct 2024

Compared with peers

Next to other Dentist providers in Minnesota

Rank by total paid#74 of 192

Median peer was paid$9K

This provider vs. median2.8×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	118	$0.00
2019	190	$7K
2020	48	$2K
2021	37	$789.61
2022	123	$5K
2023	182	$7K
2024incomplete	144	$5K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	42%	258	256	$11K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	37%	388	377	$10K
D1206	Topical application of fluoride varnish	11%	128	125	$3K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	4.8%	15	12	$1K
D0274	Bitewings - four radiographic images	3.2%	24	24	$818.34
D1120	Dental cleaning, childProphylaxis - child	1.7%	14	14	$439.39
D0330	Panoramic radiographic image	0%	15	13	$0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialHOLCOMBE, STEVEN (PRESIDENT)